Stroke Flashcards
Broca’s area location, blood supply, function
inferior frontal gyrus, anterior to articulatory areas of primary motor cortex; LEFT BRAIN
blood: superior division MCA
function: word production (motor)
Wernicke’s area location, blood supply, function
superior temporal gyrus, adjacent to primary auditory cortex, inferior to sylvian fissure. LEFT BRAIN
Blood: inferior division MCA
Function: language processing. damage can lead to fluent aphasia, difficulty understanding language
association cortex, location, function, blood supply
nondominant hemisphere (usually right)
attention to contralateral body and space
blood: MCA
primary visual cortex location and function and blood supply
calcarine fissure of occipital lobe.
Function: vision
Blood: PCA
what are optic radiations? location?
white matter pathways carrying visual info. damage can lead to field deficits.
location: travel from thalamus to visual cortex. pass under parietal and temporal cortex.
blood: PCA, MCA
what are lenticulostriate arteries? prone to what injury?
branches from MCA. supply basal ganglia and internal capsule.
in HTN, prone to narrowing leading to lacunar infarct. or rupture leading to intracerebral hemorrhage.
what perfused by anterior choroidal artery? source of this artery?
from internal carotid artery. to globus pallidus, putamen, thalamus, posterior limb internal capsule (corticobulbar and corticospinal tract)
what perfused by thalamoperforator arteries? blood from where?
to thalamus and portion of posterior limb of internal capsule.
arise from proximal posterior cerebral arteries near top basilar artery.
what perfused by recurrent artery of Heubner? arises from?
head of caudate, anterior putamen, globus pallidus, internal capsule.
arises from anterior cerebral artery
Large MCA infarcts gaze preference toward….
side of lesion. especially acutely.
small-vessel infarcts called? most common cause?
lacunar infarcts. chronic hypertension.
source of embolus (5)
- cardioembolic infarcts: originates in heart, occurs in conditions such as atrial fibrillation (thrombi at fibrillating left atrial appendage), myocardial infarction (thrombi form on hypokinetic or akinetic regions of infarcted myocardium), valvular disease (thrombi form on valved leaflets or prosthetic parts)
- artery-to-artery emboli (from stenosed segment of internal carotid artery), vertebral stenosis,, ectatic dilated basilar artery
- dissection: of carotid or vertebral arteries resulting in thrombus formation that can embolize to brain
- atherosclerotic disease in aortic arch
- patent foramen ovale: allows thromboembolus in venous system to bypass lungs and pass to lleft side heart to brain.
pure motor hemiparesis (lacunar infarct). symptoms, location, blood supply
symptoms: unilateral face, arm, leg weakness with dysarthria.
location: posterior limb internal capsule (lenticulostriate arteries, anterior choroidal artery, perforating branches posterior cerebral artery), ventral pons (ventral penetrating branches basilar artery), corona radiata (MCA branches), cerebral peduncle (PCA branches)
ataxic hemiparesis (lacunar infarct) symptoms? location? blood supply?
symptoms: unilateral face, arm, leg weakness with dysarthria and ataxia on same side weakness
location: posterior limb internal capsule (lenticulostriate arteries, anterior choroidal artery, perforating branches posterior cerebral artery), ventral pons (ventral penetrating branches basilar artery), corona radiata (MCA branches), cerebral peduncle (PCA branches)
pure sensory (thalamic) lacunar infarct
location: ventral posterior lateral nucleus of thalamus (thalamoperforator branches of PCA)
symptoms: sensory loss of primary modalities in contralateral face/ body, sometimes thalamic pain syndrome
sensorimotor lacunar infarct. symptoms? location? blood supply?
symptoms: combination sensory and motor deficits contralateral side
location: posterior limb internal capsule and either thalamic VPL or thalamic somatosensory radiation (branches PCA or lenticulostriate arteries of MCA)
basal ganglia lacunar infarct
symptoms: usually asymptomatic but may cause hemiballismus (involuntary wild flinging movement of one side arm/leg)
location: ccaudate, putamen, globus pallidus, or subthalamic nubleus (lenticulostriate of MCA, anterior choroidal of IC or Heubner’s arteries of ACA)
common risk factors stroke?
HTN, DM, hypercholesterolemia, smoking, family history, cardiac disease (valvular disease, afib, patent foramen ovale, low EF), prior history of stroke or vascular disease
headache most common for anterior or posterior circulation infarcts?
headache more common posterior circ. infarct. headache in 25-30% of ischemic strokes
where do lacunar infarcts occur?
affect deep white matter and nuclei of cerebral hemispheres and brainstem.
tissue plasminogen activator (tPA). who gets it?
no hemorrhage on CT and symptoms started within 4.5 hours.
risks tPA?
increase risk intracranial and systemic hemorrhage.
preventive measures after stroke.
modifiable risk factors: HTN, smoking, hypercholesterolemia), statins, aspirin
bruit
whooshing sound in carotid upon auscultation. continues into diastole
tests for carotid patency?
Doppler ultrasound, magnetic resonance angiography (MRA), CT angiography (CTA), conventional angiography is only occasionally needed as the “gold standard”
treatment for 100% occluded vs. partially occluded carotid artery
100% occluded treat with anti-coagulant bc risk surgery and throwing clot too high.
partial occlusion: carotid endarterectomy: clean out plaque.
also exploring stents and angioplasty (for those with high surgical risk for traditional carotid endarterectomy)
dissection of artery
small tear on intimal surface of artery, allows blood to burrow into vessel wall producing dissection. flap protrudes into vessel lumen and thrombus forms. can embolize distally.
